A family has contacted the agency that you work for to report that they think their son, Brian (aged in his mid-twenties), is suffering from an extreme case of schizophrenia. They note that they feel his symptoms have been ongoing for a number of months and, as a result of going untreated, have worsened to the extent that he has become both unpredictable and, at times, aggressive. They are worried for his safety and well-being, and, knowing your agency’s mandate, request that you attend their home to check in on him and do an assessment to determine if he needs to be taken to the hospital voluntarily or, depending on his presentation and willingness to attend the hospital, involuntarily.

You attend the home where the family lives with the aid of police. After discussing the client’s situation with his family, you ask to speak with Brian and conduct the assessment to get a better picture of his mental health; however, it is soon discovered that Brian is hiding in a bathroom. You speak to Brian through the bathroom door, during which he refuses, in a monotone, circular, and somewhat catatonic-style of voice to engage with you and states that he does not want to go to the hospital and does not feel he needs treatment. Based on the collateral gathered from the family indicating Brian’s potential mental deterioration, as well as Brian’s catatonic-style of presentation through the door, you contemplate whether you should take Brian into involuntary care under the Involuntary Psychiatric Treatment Act (IPTA-which outlines that a client can be taken into mental healthcare involuntarily based on imminent threat to self, others, or a high likelihood of physical or mental deterioration). On the other hand, you also consider the lack of direct assessment and visual on Brian that is leaving out potentially important information such as the extent that Brian’s functioning has become impaired by his symptoms, as well as the need to balance his rights to self-determination and autonomy with any clinical decisions that you make. You are therefore left with a major ethical decision—whether or not to take Brian into involuntary care—that you must act on in-the-moment based on the information in front of you. Should you decide to take Brian into care based on the extent to which the collateral you have received indicates that he meets the grounds for IPTA and his current presentation, he may receive long-needed treatment that could benefit his mental health and his life as a whole; however, his right to autonomy would also be neglected. Conversely, if you do not take him into care, you will hold his rights to self-determination and autonomy as paramount, but also leave him susceptible to the potential for ongoing mental health deterioration and impacts to his functioning.

The IPTA can be viewed here (most relevant section to this case is s.14, found on page 9).

1) What would you, personally, do in this situation, based on the information provided?

2) To what extent do you believe client autonomy needs to be upheld in the context of mental health presentations that reflect a potential risk to clients and others?

3) Where do you perceive the line needing to be drawn between respecting a client’s rights to self-determination and autonomy, and ensuring that they are able to stay safe and that their mental health does not worsen?

4) To what extent do you believe practitioners should value the collateral received from family members? Is it enough to make decisions about a client’s care?

5) How do you perceive involuntary mental healthcare as fitting in with anti-oppressive social work practice?

6) What is your perspective on the Involuntary Psychiatric Treatment Act, especially s. 14, as a piece of legislation that provides a guiding point for mental healthcare in Nova Scotia and, by extension, mental health social work practice?